COMPARISON OF FACTORS INFLUENCING THE PROGNOSIS OF JAPANESE, GERMAN, AND DUTCH GASTRIC-CANCER PATIENTS
COMPARISON OF FACTORS INFLUENCING THE PROGNOSIS OF JAPANESE, GERMAN, AND DUTCH GASTRIC-CANCER PATIENTS
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DOI：
10.1007/bf01658714
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发表时间：
1993-05-01
影响因子：
2.6
通讯作者：
MARUYAMA, K
中科院分区：
文献类型：
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作者：
BONENKAMP, JJ;VANDEVELDE, CJH;MARUYAMA, K
日本报道称扩大淋巴结清扫术后胃癌患者的生存率有所提高，因此开展了一项研究来评估可能影响这些结果的因素。通过对日本国家癌症中心的 1085 名患者进行分层并根据三种常用系统进行分组来评估分期的影响； UICC的新旧TNM系统（第四版）和日本胃癌研究会（JRSGC）的系统。除 II 期外，三个系统的各个阶段之间没有发现生存差异，其中新 TNM 和 JRSGC 存在差异 (p < 0.05)。在第二项分析中，比较了三个机构之间晚期胃癌最重要预后因素的发生率：日本东京国家癌症中心 (NCC)、德国埃尔兰根大学医院 (UHE) 和荷兰马斯特里赫特大学医院 (UHM)。日本患者比德国患者平均年轻 3 岁，比荷兰患者平均年轻 8 岁，并且晚期 (T4) 癌症的比例更高。三组的男女分布、组织学和淋巴结侵袭情况相当。从这些数据来看，日本晚期胃癌患者的预后可能会更差。然而，观察到的 5 年生存率显示日本患者具有明显优势：57% (NCC) 对比 34% (UHE) 和 31% (UHM)。新 TNM 和 JRSGC 分期系统之间 II 期患者的生存差异不足以解释这一优势。这一结果强调了日本治疗方法的重要性。这种方法（即扩大淋巴结清扫术）是否真的能提高生存率或仅仅改善分类，目前是荷兰一项前瞻性随机试验的主题。
As a result of Japanese reports of improved survival of gastric cancer patients after extended lymph node dissection, a study was undertaken to evaluate factors that might influence these results. The influence of staging was evaluated by stratifying 1085 patients of the National Cancer Center of Japan and grouping them according to the three commonly used systems; UICC's old and new TNM systems (fourth edition) and the system of the Japanese Research Society for the study of Gastric Cancer (JRSGC). No survival difference was found between the stages of the three systems, except for stage II, where the new TNM and the JRSGC differed (p < 0.05). In a second analysis, the incidence of the most important prognostic factors for advanced gastric cancer was compared among three institutions: the National Cancer Center Tokyo, Japan (NCC), the University Hospital Erlangen, Germany (UHE) and the University Hospital Maastricht in The Netherlands (UHM). Japanese patients were on average 3 years younger than the German patients and 8 years younger than the Dutch patients, and had a higher proportion of advanced (T4) carcinomas. Male-female distribution, histology, and lymph node invasion were comparable in the three groups. From these data a rather worse prognosis for Japanese advanced gastric cancer patients could be expected. However, the observed 5-year survival rates show a marked advantage for the Japanese patients: 57% (NCC) versus 34% (UHE) and 31% (UHM). The survival difference for stage II patients between the new TNM and the JRSGC staging systems is not sufficient to explain this advantage. This result underlines the importance of the Japanese therapeutic approach. Whether this approach (i.e., extended lymph node dissection) actually improves survival or merely improves classification, is currently the subject of a prospective randomized trial in The Netherlands.